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Epilepsy

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					Epilepsy




Epilepsy involves a disturbance in the brain’s normal electrical
activity. Although it can take many different forms, the term
‘epilepsy’ refers to recurrent seizures of which there are four main
types (outlined below). Epilepsy most commonly starts in childhood
or adolescence. However, it can develop in anyone regardless of age,
sex, background or intellectual ability.
Each child or young person’s experience will be unique with the severity of
symptoms and frequency of attacks varying enormously. Some may get a
warning sign before a seizure, such as strange feeling or familiar smell, while for
others the seizure will come on very suddenly with no warning.
Epilepsy occurs in around 1 in 100 pre-school children and in approximately 5 in
1000 older children and adults. Children will not be diagnosed as having
epilepsy unless a tendency for repeated seizure is identified.

The four main types of seizure
• Absence seizures (previously called ‘petit mal’). These mainly affect children.
  The child may stop what they are doing, look blank for a few seconds and
  their eyelids may twitch or blink. The child may have dozens of seizures a
  day.
• Tonic–clonic seizures (previously called ‘grand mal’). The child may cry out,
  stiffen up and fall to the floor then go into convulsions (when the body jerks
  and twitches). Sometimes the child will wet or soil him or herself during a
  seizure. The convulsions will usually last for one or two minutes.
• Partial seizures. The child may experience a range of unusual sensations
  such as tingling, twitching or numbness in a certain part of the body or a
  particular smell or taste, or they may have a feeling of panic, déjà vu or
  elation. The child may be confused and disorientated but remain conscious.
• Complex partial seizures. The child may be disorientated, become unaware
  of their surroundings and lose their sense of time. They might be motionless
  or behave in random ways, e.g. plucking at clothes, slurring or repeating
  words, wandering about aimlessly or even taking their clothes off. This type
  of seizure commonly lasts for less than three minutes.




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                  Management of epilepsy
                  Anticonvulsant medication is the mainstay of epilepsy management. Commonly
                  used drugs include:
                  • sodium valproate (epilim)
                  • carbamazepine (tegretol)
                  • phenytoin (epanutin)
                  • clobazam
                  • lamotrigine.

                  Drugs do not cure epilepsy. However, they can reduce the frequency and
                  duration of seizures. Most seizures will stop spontaneously within five minutes.
                  The risk to safety increases when a seizure lasts longer than five minutes.
                  Status epilepticus is the name for a prolonged seizure. Emergency medication
                  may be required to stop prolonged seizures.
                  Every child who is diagnosed with epilepsy should have a care plan detailing all
                  aspects of their management.
                  Training for carers in epilepsy, first aid management of seizures and the
                  administration of emergency medication is provided by Enlighten (see Useful
                  contacts) and local paediatric services, and can be accessed via a social work
                  department.

                  Triggers
                  Different things can trigger a seizure for different children and young people.
                  Some of the more common triggers include:
                  • lack of sleep, tiredness and stress
                  • illness
                  • not taking medication as directed
                  • lack of food
                  • having a period
                  • television flickering or flashing lights (photosensitivity), which affects up to
                     5% of people with epilepsy
                  • alcohol withdrawal and recreational drug use.




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What can I do?
During and after an absence seizure, a partial seizure or a complex partial
seizure
• Make sure the child is safe and not at risk of harming themselves.
• Do not try to stop the seizure.
• Give them time to recover.
• Stay calm and give them reassurance that they are okay.

During a tonic-clonic seizure
• Be familiar with and follow the epilepsy care plan for the individual child.
• Note the time when the seizure started.
• Stay calm. Although it looks dramatic, the child isn’t in pain from the seizure.
• Make sure the child is safe and not at risk of harming themselves.
• Cushion the head and loosen tight clothing.
• As soon as the fitting stops, turn the child on his/her side into the recovery
  position and check the airway is clear.
• As they ‘come to’, try to offer reassurance and acknowledge what has
  happened.
• If the seizure is prolonged (over five minutes) follow the steps noted in the
  person’s care plan.
• If you are unsure or unable to implement the management plan, dial 999 for
  an ambulance.
• If the child has never had a seizure before, contact their GP.

Actions to avoid
• Do not move the person unless they are at risk, e.g. near a fire or at the top
  of a flight of stairs.
• Do not try to sit the person up or restrict their movements.
• Do not force anything between their teeth.

In the longer term
• Build up your confidence – find out as much as you can about epilepsy (see
   Useful contacts) and get to know the individual child’s experience, e.g. their
   particular triggers, warning signs, and the type of seizures they experience.




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                  • Get some advice on safety issues, e.g. children with epilepsy are normally
                    advised to sit down in the shower or have a shallow bath and not to lock the
                    bathroom door.
                  • Some epilepsy medication can interact with various contraception methods
                    and the young person should be encouraged to discuss this with their
                    epilepsy specialist nurse or GP.
                  • Don’t solely focus on the epilepsy – encourage the child to focus on what
                    they can do, not what they can’t.
                  • Avoid being overprotective – try to support the child to develop their
                    confidence so that they can better deal with different situations.



               Y            Points to ponder/training ideas
                       • How might you ensure the child isn’t isolated or excluded?
                       • Who needs to know about the child’s epilepsy and how much do they
                         need to know?
                       • Children with epilepsy are sometimes the target of teasing and bullying –
                         is this an issue for this child?
                       • Are there specific training needs for staff? How might you become aware
                         of such training?
                       • Safety issues, e.g. how do you ensure the child has privacy in the
                         bathroom without locking the door?
                       • How might you explain epilepsy to other children and young people?
                       • Alcohol affects the absorption of related medication – is this an issue to
                         be considered?

                  Links to other topics in this pack
                  See: Bullying; Resilience.




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E   Useful contacts
    Epilepsy Action
    Epilepsy Action is the largest member-led epilepsy organisation in Britain,
    acting as the voice for those with epilepsy, as well as their friends,
    families, carers, health professionals.
    Tel: 0113 210 8800
    Helpline: Tel. 0808-800-5050 (Mon–Thurs 9 am–4.30 pm,
    Fri 9 am–4 pm)
    Website: www.epilepsy.org.uk

    Epilepsy Scotland
    The Helpline is normally open weekdays. They also have a range of
    14 factsheets, information packs, booklets and videos.
    Epilepsy Scotland
    48 Govan Road
    Glasgow
    G51 1JL
    Tel: 0141 427 4911
    Helpline: 0808 800 2200
    Website: www.epilepsyscotland.org.uk



9   Useful leaflets/resources
    The following leaflets are available from Epilepsy Action
    (see Useful contacts):

    Epilepsy – A Parent’s Guide.

    Epilepsy and Leisure.

    Information Pack – 52-page pack of 20 factsheets. Available from
    Enlighten (see Useful Contacts).

    Epilepsy and Children, is available from the British Epilepsy Association.
    Tel: 0808 800 5050




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